Opinion

With nearly 450 sickened, 259 hospitalized and 7 deaths, is it time for a romaine Warning label? Or, are the illnesses and deaths simply a cost of doing business?

2019
41 people sickened, 28 hospitalization and 5 with HUS.A total of 40 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states: Arizona, California, Colorado, Idaho, Illinois, Maryland, Michigan, Minnesota, Montana, New Jersey, Ohio, Pennsylvania, Virginia, Washington and Wisconsin. A total of 28 hospitalizations have been reported. Five people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.  Canada has reported one illness.

23 people sickened and 11 hospitalized. The FDA, CDC, along with state and local partners, investigated the illnesses associated with the outbreak. A total of 23 people infected with the outbreak strain of E. coli O157:H7 were reported from 12 states: Arizona, California, Florida, Georgia, Illinois, Maryland, North Carolina, Nevada, New York, Oregon, Pennsylvania  and South Carolina. Eleven people were hospitalized, and no deaths were reported. Illnesses started on dates ranging from July 12, 2019 to Sept. 8, 2019. No illnesses were reported after CDC began investigating the outbreak on Sept. 17, 2019.

2018

218 people sickened, 96 hospitalized, 27 with HUS and 5 deaths. 210 people infected with the outbreak strain were reported from 36 states. 96 people were hospitalized, including 27 people who developed a type of kidney failure called hemolytic uremic syndrome. 5 deaths were reported from Arkansas, California, Minnesota, and New York.

Illustration

In total, there were eight Canadian cases of E. coli O157 that were genetically similar to the U.S. outbreak linked to romaine lettuce coming from the Yuma growing region in the U.S. The eight Canadian illnesses were reported in five provinces: British Columbia, Alberta, Saskatchewan, Ontario, and Quebec. Individuals became sick between March and April 2018. One of the Canadian cases was hospitalized, and no deaths were reported in Canada. Individuals who became ill were between 11 and 76 years of age. The majority of cases (75%) were female.

91 people sickened, 35 hospitalized, 4 with HUS. Sixty-two people infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 were reported from 16 states and the District of Columbia. Illnesses started on dates ranging from October 7, 2018, to December 4, 2018. Twenty-five people were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths were reported. In Canada, there were a total of 29 confirmed cases of E. coli illness investigated in Ontario, Quebec, New Brunswick, and British Columbia. The illnesses in British Columbia were related to travel to Quebec, Ontario and the United States. Individuals became sick between mid-October and mid-November 2018. Ten individuals were hospitalized, and two individuals suffered from hemolytic-uremic syndrome (HUS), which is a severe complication that can result from an E. coli infection. No deaths were reported. Individuals who became ill were between 2 and 93 years of age. The majority of cases (52%) were female.

2017
76 people sickened, 9 people hospitalized, 2 with HUS and 2 deaths. Twenty-five people infected with the outbreak strain of E. coli O157:H7 were reported from 15 states. Illnesses started on dates ranging from November 5, 2017 to December 12, 2017. Nine people were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. One death was reported from California. In total, there were 42 cases of E. coli O157:H7 illness reported in five eastern provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died. Individuals who became ill were between the ages of 3 and 85 years of age. The majority of cases (74%) were female.

E. coli outbreaks associated with lettuce, specifically the “pre-washed” and “ready-to-eat” varieties, are by no means a new phenomenon. In fact, the frequency with which this country’s fresh produce consuming public has been hit by outbreaks of pathogenic bacteria is astonishing.

Here is just a sample of E. coli outbreaks based on information gathered by the Center for Science in the Public Interest, Kansas State University, and the Centers for Disease Control and Prevention. It is very likely that there are other outbreaks that the CDC and FDA did not make public.

Date Vehicle Etiology Confirmed
Cases
States &
Provinces
July 1995 Lettuce (leafy green; red; romaine) E. coli O157:H7 74 1:MT
Sept. 1995 Lettuce (romaine) E. coli O157:H7 20 1:ID
Sept. 1995 Lettuce (iceberg) E. coli O157:H7 30 1:ME
Oct. 1995 Lettuce (iceberg; unconfirmed) E. coli O157:H7 11 1:OH
May-June 1996 Lettuce (mesclun; red leaf) E. coli O157:H7 61 3:CT,
IL, NY
May 1998 Salad E. coli O157:H7 2 1:CA
Feb.-Mar. 1999 Lettuce (iceberg) E. coli O157:H7 72 1:NE
Oct. 1999 Salad E. coli O157:H7 92 3:OR,
PA, OH
Oct. 2000 Lettuce E. coli O157:H7 6 1:IN
Nov. 2001 Lettuce E. coli O157:H7 20 1:TX
July-Aug. 2002 Lettuce (romaine) E. coli O157:H7 29 2:WA, ID
Nov. 2002 Lettuce E. coli O157:H7 13 1:Il
Dec. 2002 Lettuce E. coli O157:H7 3 1:MN
Oct. 2003-May 2004 Lettuce (mixed salad) E. coli O157:H7 57 1:CA
Apr. 2004 Spinach E. coli O157:H7 16 1:CA
Nov. 2004 Lettuce E. coli O157:H7 6 1:NJ
Sept. 2005 Lettuce (romaine) E. coli O157:H7 32 3:MN,
WI, OR
Sept. 2006 Spinach (baby) E. coli O157:H7 and other serotypes 205 Multistate
and Canada
Nov./Dec. 2006 Lettuce E. coli O157:H7 71 4:NY,
NJ, PA, DE
Nov./Dec. 2006 Lettuce E. coli O157:H7 81 3:IA,
MN, WI
July 2007 Lettuce E. coli O157:H7 26 1:AL
May 2008 Romaine E. coli O157:H7 9 1:WA
Oct. 2008 Lettuce E. coli O157:H7 59 Multistate
and Canada
Nov. 2008 Lettuce E. coli O157:H7 130 Canada
Sept. 2009 Lettuce: Romaine or Iceberg E. coli O157:H7 29 Multistate
Sept. 2009 Lettuce E. coli O157:H7 10 Multistate
April 2010 Romaine E. coli O145 33 5:MI, NY,
OH, PA, TN
Oct. 2011 Romaine E. coli O157:H7 60 Multistate
April 2012 Romaine E. coli O157:H7 28

1:CA

Canada

June 2012 Romaine E. coli O157:H7 52 Multistate
Sept. 2012 Romaine E. coli O157:H7 9 1:PA
Oct. 2012 Spinach and Spring Mix Blend E. coli O157:H7 33 Multistate
Apr. 2013 Leafy Greens E. coli O157:H7 14 Multistate
Aug. 2013 Leafy Greens E. coli O157:H7 15 1:PA
Oct. 2013 Ready-To-Eat Salads E. coli O157:H7 33 Multistate
Apr. 2014 Romaine E. coli O126 4 1:MN
Apr. 2015 Leafy Greens E. coli O145 7 3:MD,
SC, VA
June 2016 Mesclun Mix E. coli O157:H7 11 3:IL,
MI, WI
Nov. 2017 Leafy Greens E. coli O157:H7 67 Multistate
and Canada
Mar. 2018 Romaine E. coli O157:H7 219 Multistate
and Canada
Nov. 2018 Romaine E. coli O157:H7 91 Multistate
and Canada
Sept. 2019 Romaine E. coli O157:H7 23 Multistate
Nov. 2019 Romaine E. coli O157:H7 41 Multistate
and Canada

We need to take a hard look at the safety of romaine and what we can do to make it safe.

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